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Early cardiac outcomes following contemporary treatment for childhood acute myeloid leukemia: A north American perspective

Authors

  • Etan Orgel MD, MS,

    1. Jonathan Jaques Children's Cancer Center, Miller Children's Hospital, Long Beach, California
    2. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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  • Laura Zung MD,

    1. LIFE Cancer Survivorship & Transition Program, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
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  • Lingyun Ji MS,

    1. Department of Preventive Medicine, Keck School of Medicine/USC Norris Comprehensive Cancer Center, Los Angeles, California
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  • Jerry Finklestein MD,

    1. Jonathan Jaques Children's Cancer Center, Miller Children's Hospital, Long Beach, California
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  • James Feusner MD,

    1. Department of Hematology/Oncology, Children's Hospital and Research Center, Oakland, California
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  • David R. Freyer DO, MS

    Corresponding author
    1. LIFE Cancer Survivorship & Transition Program, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
    • Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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  • This article was presented in part at the American Society of Pediatric Hematology Oncology (ASPHO) 2011 Annual Meeting.
  • Conflict of interest: Nothing to declare.

Correspondence to: David R. Freyer, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mail Code 54, Los Angeles, CA 90027-6016.

E-mail: dfreyer@chla.usc.edu

Abstract

Background

Anthracycline agents are used for treatment of acute myeloid leukemia (AML) but may cause late-onset cardiomyopathy. Current frontline therapy for AML in North America, as reflected in the approach of the Children's Oncology Group (COG) and other pediatric consortia, is adapted from the anthracyline-intensive Medical Research Council (MRC) regimen. The purpose of this study was to describe early post-treatment cardiac function as a potential indicator of acute and long-term risk associated with this approach.

Procedure

A multi-center retrospective cohort analysis was conducted of AML survivors diagnosed from 2004 to 2009 and treated with MRC-based regimens. Change in left ventricular shortening fraction (LVSF) on echocardiogram was determined from baseline to latest post-treatment/pre-relapse value; associations with potential predictors were examined.

Results

This cohort of pediatric survivors (n = 52) was assessed at a median interval of 13 months from end of treatment. Mean cumulative anthracycline dose was 339 ± 14 mg/m2. Mean baseline and post-treatment LVSF were 39.3 ± 0.8% and 35.4 ± 0.9%, respectively; mean percent change for individuals was −8.4 ± 2.8% (P < 0.001). Cardiac-directed medications were initiated in four patients (7.7%). Decline in LVSF was significantly associated with cumulative anthracycline dose, increasing BMI and Hispanic ethnicity.

Conclusion

Early, significant decline in LVSF was observed following treatment with these MRC-based regimens. Elevated BMI and Hispanic ethnicity were identified as new independent risk factors. Children and adolescents so treated are at substantial risk for late-onset cardiomyopathy, require monitoring with annual echocardiogram per current COG survivorship guidelines, and are good candidates for appropriate cardioprotection strategies. Pediatr Blood Cancer 2013;160:1528–1533. © 2013 Wiley Periodicals, Inc.

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